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BMC Cancer. 2017 Aug 14;17(1):543. doi: 10.1186/s12885-017-3512-1.

Reducing the socioeconomic gradient in uptake of the NHS bowel cancer screening Programme using a simplified supplementary information leaflet: a cluster-randomised trial.

Author information

1
Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9LB, UK.
2
Department of Behavioural Science and Health, University College London, London, WC1E 7HB, UK.
3
Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, W2 1NY, UK.
4
Department of Applied Health Research, University College London, London, WC1E 7HB, UK.
5
Research & Enterprise Royal Holloway University of London, London, England.
6
Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, EC1M 6BQ, UK.
7
Cancer Research UK & UCL Cancer Trials Centre, University College London, London, WC1E 7HB, UK.
8
Bowel Cancer Screening Southern Programme Hub, Guildford, GU2 7XX, UK.
9
Academic Neuroscience Centre, King's College London, London, SE5 8AF, UK.
10
North East Bowel Cancer Screening Hub, Gateshead, NE9 6SX, UK.
11
Eastern Hub of the Bowel Cancer Screening Programme, Nottingham, NG7 2UH, UK.
12
Bowel Cancer Screening Programme London Programme Hub, London, HA1 3UJ, UK.
13
Midlands & North West Bowel Cancer Screening Programme Hub, Rugby, CV22 5PX, UK.
14
Department of Behavioural Science and Health, University College London, London, WC1E 7HB, UK. c.wagner@ucl.ac.uk.

Abstract

BACKGROUND:

Uptake of colorectal cancer screening is low in the English NHS Bowel Cancer Screening Programme (BCSP). Participation in screening is strongly associated with socioeconomic status. The aim of this study was to determine whether a supplementary leaflet providing the 'gist' of guaiac-based Faecal Occult Blood test (gFOBt) screening for colorectal cancer could reduce the socioeconomic status (SES) gradient in uptake in the English NHS BCSP.

METHODS:

The trial was integrated within routine BCSP operations in November 2012. Using a cluster randomised controlled design all adults aged 59-74 years who were being routinely invited to complete the gFOBt were randomised based on day of invitation. The Index of Multiple Deprivation was used to create SES quintiles. The control group received the standard information booklet ('SI'). The intervention group received the SI booklet and the Gist leaflet ('SI + Gist') which had been designed to help people with lower literacy engage with the invitation. Blinding of hubs was not possible and invited subjects were not made aware of a comparator condition. The primary outcome was the gradient in uptake across IMD quintiles.

RESULTS:

In November 2012, 163,525 individuals were allocated to either the 'SI' intervention (n = 79,104) or the 'SI + Gist' group (n = 84,421). Overall uptake was similar between the intervention and control groups (SI: 57.3% and SI + Gist: 57.6%; OR = 1.02, 95% CI: 0.92-1.13, p = 0.77). Uptake was 42.0% (SI) vs. 43.0% (SI + Gist) in the most deprived quintile and 65.6% vs. 65.8% in the least deprived quintile (interaction p = 0.48). The SES gradient in uptake was similar between the study groups within age, gender, hub and screening round sub-groups.

CONCLUSIONS:

Providing supplementary simplified information in addition to the standard information booklet did not reduce the SES gradient in uptake in the NHS BCSP. The effectiveness of the Gist leaflet when used alone should be explored in future research.

TRIAL REGISTRATION:

ISRCTN74121020 , registered: 17/20/2012.

KEYWORDS:

Cancer; oncology; socioeconomic inequalities; Colorectal cancer screening; Fuzzy trace theory; Gist

PMID:
28806955
PMCID:
PMC5556676
DOI:
10.1186/s12885-017-3512-1
[Indexed for MEDLINE]
Free PMC Article

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